| NPI | 1699954743 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 18243) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019676) |
| 1223G0001X Dentist General Practice (Licence: FL DN 18243) | |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2010-04-13 |